Role of high-dose chemotherapy and autologous stem cell transplantation in patients with diffuse large B-cell lymphoma


High-dose chemotherapy (HD-CT) in combination with autologous stem cell transplantation (auto-SCT) has long become the gold standard treatment for chemosensitive recurrences and refractory diffuse large B-cell lymphoma (DLBCL). By taking into account the low efficiency of rescue therapy (postrecurrence five-year survival rate is not more than 10-20%), it is clear that the results of treatment should be improved in the induction of the first remission. The study performed in the rituximab time showed the higher efficiency of first-line therapy using auto-SCT. Therapeutic effectiveness was also noted to depend on the intensity of pretransplantation regimens. Indications for HD-CT with auto-SCT must be substantiated because of the higher toxicity together with therapy intensification. Conventional clinical criteria for this are insufficient. Thus, it is necessary to search for new molecular genetic prognostic factors that will be able to portray tumor biology.

Full Text

Роль высокодозной химиотерапии и трансплантации аутологичных стволовых клеток крови у пациентов с диффузной В-крупноклеточной лимфомой. - Аннотация. Высокодозная химиотерапия (ВД-ХТ) с трансплантацией аутологичных стволовых клеток крови (ауто-ТСКК) давно стала "золотым стандартом" лечения химиочувствительных рецидивов и рефрактерных форм диффузной В-крупноклеточной лимфомы (ДВККЛ). С учетом крайне низкой эффективности терапии спасения (5-летняя выживаемость после рецидива не превышает 10-20%) становится ясно, что необходимо улучшать результаты лечения больных в индукции первой ремиссии. Исследования, выполненные в эру ритуксимаба, показали увеличение эффективности первой линии терапии с применением ауто-ТСКК. Кроме того отмечено, что эффективность терапии зависит от интенсивности предтрансплантационных режимов. Показания к проведению ВД-ХТ с ауто-ТСКК должны быть обоснованными ввиду повышения токсичности вместе с интенсификацией терапии. Общепринятых клинических критериев для этого становится недостаточно. Таким образом, необходим поиск новых молекулярно-генетических факторов прогноза, которые смогут отразить биологию опухоли.


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